Long-Term Back Pain
(HealthScoutNews) -- Epidurals, used for pain relief during
labor, don't seem to cause the back problems later on that many
British researchers have found no significant differences in
self-reported low back pain or disability in women who received
epidurals and those who got other kinds of labor pain relief.
The report appears in tomorrow's issue of the British Medical
The researchers assigned 369 first-time mothers-to-be either
to a group that received an epidural for pain relief or to a group
that got various other forms of pain relief. An epidural is a
local anesthetic, delivered in the small of the back, just outside
the spinal canal. It lets a woman remain conscious during childbirth.
Then, they asked the women to participate in a follow-up study
to track back pain and other problems; 151 from the epidural group
and 155 from the non-epidural group participated. The researchers
say they were prompted to do the study because several studies
on back pain and epidurals have produced inconsistent results.
"We found no real surprises, and the study merely confirmed
what we already suspected: that there was no causal association
between epidurals for labor and long-term backache," says
lead author Dr. Charlotte Howell, a consultant anesthetist at
the North Staffordshire Hospital Trust, in Stoke on Trent, Staffordshire.
"But it was interesting to see how similar the groups were
in terms of the results," Howell adds.
Back pain, however, was common in both groups. More women in
the epidural group reported severe pain, the researchers found.
However, pain lasting more than a year was more common among the
women who did not receive an epidural, with 64 women in the non-epidural
group having pain for more than a year and 47 of those in the
epidural group having pain that long.
"It is highly likely that long-term backache following
pregnancy is due to the pregnancy itself," Howell says. "But
this is difficult to establish because many women have back pain
and many women also use epidurals. They tend to associate the
two, and this will probably continue to be the case."
Women wondering what pain relief is best for them during labor
should consult their anesthesiologist. "There is rarely a
good reason to advise a woman against an epidural for labor, and
no evidence to suggest that epidurals make established back pain
worse," Howell adds.
Anesthesia experts have mostly praise for the study.
"This is an obvious finding for those of us who practice
in this arena," says Christopher Stein, president of the
California Association of Nurse Anesthetists who works in pain
management and has experience in obstetrical pain relief.
Still, he says the study may help dispel misconceptions about
epidurals that persist among some women, who may avoid them due
to what they mistakenly think is a higher risk for lower back
"The study has a good random sample," Stein adds.
However, he does see a few flaws. "They didn't control
for who was doing the epidural," he says, although he concedes
that would be difficult to do. Still, the skill of the operator,
he adds, can make a difference. Also, they didn't ask about preexisting
"Epidurals are very safe," adds Dr. Michael Ferrante,
an anesthesiologist at Santa Monica-UCLA Medical Center and co-director
of the UCLA Spine Center. "There is no trauma, except to
the soft tissue and that heals within two weeks or so."
He often hears concerns about epidurals raising the risk of
low back pain, but tells patients it is "pure superstition."
The latest study, he says, "is nice, though a little bit
flawed." He, like Stein, points out the researchers did not
control for preexisting back pain.
What To Do
For information on different forms of pain relief during childbirth,
The American Association of Nurse Anesthetists or the
American Society of Anesthesiologists.
Reference Source 89